Need Custom Zoho Form Built to Collect User Sign Ups -- 2

Need a custom form built to collect user sign ups and pass the info to Zoho. They have a form builder, but we need the form to look a certain way on the website. The form needs to collect first & last name, email, nickname, & the user needs to pick 1 category from 5 choices we'll offer. the form needs to look like the one currently on our website, but needs to be able to pass the info to Zoho. Current form can be seen at [login to view URL]